Filtered QRS Duration on Signal-Averaged Electrocardiography Predicts Inducibility of Ventricular Tachycardia in Arrhythmogenic Right Ventricle Dysplasia

Khurram Nasir, Harikrishna Tandri, Julie Rutberg, Crystal Tichnell, Phil Spevak, Jane Crossan, Kenneth L. Baughman, Edward K. Kasper, Gordon F. Tomaselli, Ronald Berger, Hugh Calkins

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Treatment of arrhythmogenic right ventricular dysplasia (ARVD) is mostly based on the prevention of sudden cardiac death that results from arrhythmias. A clinical history suggestive of ARVD requires careful evaluation including electrophysiological study. The potential ability to identify those patients who will have inducible VT with electrophysiological study will enable better risk stratification and selection of vulnerable patients for electrophysiologically guided therapy. The purpose of the study was to evaluate the predictive ability of signal-averaged electrocardiography (SAECG) to predict inducibility of VT in patients with ARVD. The patient population consisted of 31 ARVD patients diagnosed with McKenna's criteria who underwent electrophysiological study. Electrophysiological study was considered positive if sustained monomorphic VT was induced. The sensitivity, specificity, and predictive accuracy of various SAECG criteria for inducibility of sustained monomorphic VT were also calculated. Twenty-one patients had inducible VT. The filtered QRS duration (fQRS), duration of signal <40 uV (LAS40), and root mean square voltage in the last 40 ms of QRS duration (RMS40) in ARVD patients induced versus noninduced were 122 ± 21 and 103 ± 8 ms (P = 0.007), 45 ± 20 and 28 ± 14 ms (P = 0.02), 19 ± 19 and 32 ± 22 uV (0.03), respectively. The ejection fractions were comparable in both groups. fQRS duration ≥110 ms had sensitivity of 91%, specificity of 90%, and a total predictive accuracy of 90% in predicting inducibility of VT in these patients. Filtered QRS duration on SAECG is predictive of electrophysiological study outcome in ARVD. Further studies will be needed to determine if SAECG results can predict the development of ventricular arrhythmias during follow-up.

Original languageEnglish (US)
Pages (from-to)1955-1960
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2003
Externally publishedYes

Fingerprint

Arrhythmogenic Right Ventricular Dysplasia
Ventricular Tachycardia
Heart Ventricles
Electrocardiography
Cardiac Arrhythmias
Sensitivity and Specificity
Sudden Cardiac Death
Patient Selection
Outcome Assessment (Health Care)
Therapeutics
Population

Keywords

  • ARVD
  • Electrophysiological study
  • SAECG
  • VT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Filtered QRS Duration on Signal-Averaged Electrocardiography Predicts Inducibility of Ventricular Tachycardia in Arrhythmogenic Right Ventricle Dysplasia. / Nasir, Khurram; Tandri, Harikrishna; Rutberg, Julie; Tichnell, Crystal; Spevak, Phil; Crossan, Jane; Baughman, Kenneth L.; Kasper, Edward K.; Tomaselli, Gordon F.; Berger, Ronald; Calkins, Hugh.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 26, No. 10, 01.10.2003, p. 1955-1960.

Research output: Contribution to journalArticle

Nasir, Khurram ; Tandri, Harikrishna ; Rutberg, Julie ; Tichnell, Crystal ; Spevak, Phil ; Crossan, Jane ; Baughman, Kenneth L. ; Kasper, Edward K. ; Tomaselli, Gordon F. ; Berger, Ronald ; Calkins, Hugh. / Filtered QRS Duration on Signal-Averaged Electrocardiography Predicts Inducibility of Ventricular Tachycardia in Arrhythmogenic Right Ventricle Dysplasia. In: PACE - Pacing and Clinical Electrophysiology. 2003 ; Vol. 26, No. 10. pp. 1955-1960.
@article{7cba1f6b4e7a4974ae2060bdcf057cbb,
title = "Filtered QRS Duration on Signal-Averaged Electrocardiography Predicts Inducibility of Ventricular Tachycardia in Arrhythmogenic Right Ventricle Dysplasia",
abstract = "Treatment of arrhythmogenic right ventricular dysplasia (ARVD) is mostly based on the prevention of sudden cardiac death that results from arrhythmias. A clinical history suggestive of ARVD requires careful evaluation including electrophysiological study. The potential ability to identify those patients who will have inducible VT with electrophysiological study will enable better risk stratification and selection of vulnerable patients for electrophysiologically guided therapy. The purpose of the study was to evaluate the predictive ability of signal-averaged electrocardiography (SAECG) to predict inducibility of VT in patients with ARVD. The patient population consisted of 31 ARVD patients diagnosed with McKenna's criteria who underwent electrophysiological study. Electrophysiological study was considered positive if sustained monomorphic VT was induced. The sensitivity, specificity, and predictive accuracy of various SAECG criteria for inducibility of sustained monomorphic VT were also calculated. Twenty-one patients had inducible VT. The filtered QRS duration (fQRS), duration of signal <40 uV (LAS40), and root mean square voltage in the last 40 ms of QRS duration (RMS40) in ARVD patients induced versus noninduced were 122 ± 21 and 103 ± 8 ms (P = 0.007), 45 ± 20 and 28 ± 14 ms (P = 0.02), 19 ± 19 and 32 ± 22 uV (0.03), respectively. The ejection fractions were comparable in both groups. fQRS duration ≥110 ms had sensitivity of 91{\%}, specificity of 90{\%}, and a total predictive accuracy of 90{\%} in predicting inducibility of VT in these patients. Filtered QRS duration on SAECG is predictive of electrophysiological study outcome in ARVD. Further studies will be needed to determine if SAECG results can predict the development of ventricular arrhythmias during follow-up.",
keywords = "ARVD, Electrophysiological study, SAECG, VT",
author = "Khurram Nasir and Harikrishna Tandri and Julie Rutberg and Crystal Tichnell and Phil Spevak and Jane Crossan and Baughman, {Kenneth L.} and Kasper, {Edward K.} and Tomaselli, {Gordon F.} and Ronald Berger and Hugh Calkins",
year = "2003",
month = "10",
day = "1",
doi = "10.1046/j.1460-9592.2003.00302.x",
language = "English (US)",
volume = "26",
pages = "1955--1960",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Filtered QRS Duration on Signal-Averaged Electrocardiography Predicts Inducibility of Ventricular Tachycardia in Arrhythmogenic Right Ventricle Dysplasia

AU - Nasir, Khurram

AU - Tandri, Harikrishna

AU - Rutberg, Julie

AU - Tichnell, Crystal

AU - Spevak, Phil

AU - Crossan, Jane

AU - Baughman, Kenneth L.

AU - Kasper, Edward K.

AU - Tomaselli, Gordon F.

AU - Berger, Ronald

AU - Calkins, Hugh

PY - 2003/10/1

Y1 - 2003/10/1

N2 - Treatment of arrhythmogenic right ventricular dysplasia (ARVD) is mostly based on the prevention of sudden cardiac death that results from arrhythmias. A clinical history suggestive of ARVD requires careful evaluation including electrophysiological study. The potential ability to identify those patients who will have inducible VT with electrophysiological study will enable better risk stratification and selection of vulnerable patients for electrophysiologically guided therapy. The purpose of the study was to evaluate the predictive ability of signal-averaged electrocardiography (SAECG) to predict inducibility of VT in patients with ARVD. The patient population consisted of 31 ARVD patients diagnosed with McKenna's criteria who underwent electrophysiological study. Electrophysiological study was considered positive if sustained monomorphic VT was induced. The sensitivity, specificity, and predictive accuracy of various SAECG criteria for inducibility of sustained monomorphic VT were also calculated. Twenty-one patients had inducible VT. The filtered QRS duration (fQRS), duration of signal <40 uV (LAS40), and root mean square voltage in the last 40 ms of QRS duration (RMS40) in ARVD patients induced versus noninduced were 122 ± 21 and 103 ± 8 ms (P = 0.007), 45 ± 20 and 28 ± 14 ms (P = 0.02), 19 ± 19 and 32 ± 22 uV (0.03), respectively. The ejection fractions were comparable in both groups. fQRS duration ≥110 ms had sensitivity of 91%, specificity of 90%, and a total predictive accuracy of 90% in predicting inducibility of VT in these patients. Filtered QRS duration on SAECG is predictive of electrophysiological study outcome in ARVD. Further studies will be needed to determine if SAECG results can predict the development of ventricular arrhythmias during follow-up.

AB - Treatment of arrhythmogenic right ventricular dysplasia (ARVD) is mostly based on the prevention of sudden cardiac death that results from arrhythmias. A clinical history suggestive of ARVD requires careful evaluation including electrophysiological study. The potential ability to identify those patients who will have inducible VT with electrophysiological study will enable better risk stratification and selection of vulnerable patients for electrophysiologically guided therapy. The purpose of the study was to evaluate the predictive ability of signal-averaged electrocardiography (SAECG) to predict inducibility of VT in patients with ARVD. The patient population consisted of 31 ARVD patients diagnosed with McKenna's criteria who underwent electrophysiological study. Electrophysiological study was considered positive if sustained monomorphic VT was induced. The sensitivity, specificity, and predictive accuracy of various SAECG criteria for inducibility of sustained monomorphic VT were also calculated. Twenty-one patients had inducible VT. The filtered QRS duration (fQRS), duration of signal <40 uV (LAS40), and root mean square voltage in the last 40 ms of QRS duration (RMS40) in ARVD patients induced versus noninduced were 122 ± 21 and 103 ± 8 ms (P = 0.007), 45 ± 20 and 28 ± 14 ms (P = 0.02), 19 ± 19 and 32 ± 22 uV (0.03), respectively. The ejection fractions were comparable in both groups. fQRS duration ≥110 ms had sensitivity of 91%, specificity of 90%, and a total predictive accuracy of 90% in predicting inducibility of VT in these patients. Filtered QRS duration on SAECG is predictive of electrophysiological study outcome in ARVD. Further studies will be needed to determine if SAECG results can predict the development of ventricular arrhythmias during follow-up.

KW - ARVD

KW - Electrophysiological study

KW - SAECG

KW - VT

UR - http://www.scopus.com/inward/record.url?scp=10744227861&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10744227861&partnerID=8YFLogxK

U2 - 10.1046/j.1460-9592.2003.00302.x

DO - 10.1046/j.1460-9592.2003.00302.x

M3 - Article

VL - 26

SP - 1955

EP - 1960

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 10

ER -